What is stress echocardiography and what is it for? Stress echocardiography allows the doctor to observe what changes occur in the heart if subjected to a stimulus, or "stress", precisely, which can be both physical, induced by a muscle commitment of the patient, and pharmacological. When stress is pharmacological, the patient's heart – which during the examination is lying on the bed of the echocardiography laboratory – and its circulatory system is stimulated through the injection of specific drugs, which induce them to behave as if they were to support a physical effort. Before performing pharmacological eco stress, the cardiologist always makes an assessment of the heart through the normal echocardiogram, to consider whether the examination is technically feasible and if there are no contraindications to the execution of the examination. How does stress echocardiography take place? FARMACOLOGIC STRESS: The patient is made to lie on a cot, on the left side, as for a normal transthoracic echocardiography. Electrodes are applied to the chest to monitor the echocardiogram, and a sfigmomanometer, which monitors the progress of blood pressure. At the same time, an IV (drboclisis) administers, in a controlled dose, the drug that will cause the heart the same changes induced by physical exertion (Dobutamine) or changes in the coronary circle (Dipiridamolo). During the examination, at coded time intervals, images of the heart in motion are recorded. Intravenously, through the IV, other drugs considered necessary by the cardiologist for the favorable outcome of the test (e.g. Atropine), or to reduce the heart rate at the end of the test (metoprolol). The IV will then be removed at the end of the exam. PHYSICAL STRESS: The patient is positioned on the cycloergometer. Electrodes are applied to the chest to monitor the echocardiogram, and a sfigmomanometer, which monitors the progress of blood pressure. The patient is invited to pedal: at time intervals established by standardized international protocols, the hardness of the pedals is increased to progressively increase the workload and therefore the physical effort. During the examination, at coded time intervals, images of the heart in motion are recorded. Is stress echocardiography painful? Stress echocardiography is not a painful examination. In some cases, however, it can happen that patients with angina pectoris complain about the usual pain. This is very important for the cardiologist, as it can verify the correlation between the symptom and changes in heart function and electrocardiogram. When is the exam interrupted? The examination is interrupted when the maximum dose of medication indicated for that particular patient has been injected or when the desired frequency with exercise is reached; it can be interrupted by the cardiologist, before the completion of the protocol, even in case of the appearance of significant alterations of the electrocardiographic path or motility of the walls of the heart to the echocardiogram, for changes in the parameters at the entrances or when the patient complains of symptoms that the cardiologist deches significant. Is stress echocardiography dangerous? During this type of test, a dangerous arrhythmia, a seizure of angina, acute decompensation, a heart attack or a cardiac arrest may appear. For this reason, in the laboratory where the test is performed, drugs and tools are always available that can make each of these rare complications regress as quickly as possible. The incidence of complications is, however, the same as a normal strain test on treadmills or stationary bikes, or a spark. Preparation Before undergoing stress echocardiography, it is necessary for the patient to consult the treating physician, who will determine if necessary to suspend ongoing therapies that could address diagnostic doubt. The suspension of the drugs, which must not be decided by the tester, but by those who require it, must take place in different ways, depending on the properties of the drug itself. In principle, it should be noted that, if the treating physician has decided to have the patient suspend the current therapy, this must occur in the following ways: 48 hours before the examination for nitroderivates, calcium antagonists, ACE inhibitors, Digital, Aminophylina 5 days before the examination for beta blockers (which should be suspended gradually) In addition, it is very important that the patient: do not fumes for at least 12 hours Not , Coca Cola, coffee for at least 12 hours Sia fasting for at least 6 hours (in case of diabetes it is advisable to recommend with your treating physician, in order to establish the dose of oral antidiabetic or insulin). You can drink without special restrictions. Take with you the copy or original of the clinical documentation relating to the problem that needs to be clarified (clinical record, ECG, stress tests, coronary artery, etc.). It is preferable for the patient to show up for the accompanied examination. Exam duration: 40 minutes